| NPI | 1962682054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AK 261) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA MFC43663) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2012-10-05 |