| NPI | 1952458598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 1692) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 61) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2019-12-21 |