| NPI | 1932374816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-0421) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-10055) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |