| NPI | 1962609883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 3380) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AL S420) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2015-12-09 |