| NPI | 1871513135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 291) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: LA 2177) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-12-18 |