| NPI | 1851511497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AL 119) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 461) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-09-11 |