| NPI | 1982927547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 505) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 1779) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |