| NPI | 1912268384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR T2450) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 70797) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2024-02-09 |