| NPI | 1811464233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7800) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 7800) |
| 106H00000X Marriage & Family Therapist (Licence: LA MFT1371) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-02-13 |