| NPI | 1770801078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC1046) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC29326) |
| 101YM0800X Counselor Mental Health (Licence: MD LC1046) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2010-05-11 |