| NPI | 1881853174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 2502) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 266) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2011-06-21 |