| NPI | 1952458713 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: LA AP06313)  | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 1595)  | 
| 106H00000X Marriage & Family Therapist (Licence: LA 177)  | |
| Enumeration Date | 2007-01-04 | 
| Last Update Date | 2024-09-17 |