| NPI | 1871644674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL LPC-922) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL 922) |
| 101Y00000X Counselor (Licence: AL 77) | |
| 101Y00000X Counselor (Licence: AL LPC-922) | |
| 101YP2500X Counselor, Professional (Licence: AL LPC-922) | |
| 106H00000X Marriage & Family Therapist (Licence: AL LMFT-77) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-09-07 |