| NPI | 1811383474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL LPC-3871) |
| 106H00000X Marriage & Family Therapist (Licence: AL LMFT-L466) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2023-09-07 |