| NPI | 1821453747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA PLPC9251) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA PLM1477) |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2024-04-16 |