| NPI | 1962425470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA CEAP 002100) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY14877) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFT20970) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |