| NPI | 1992056386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA AP696) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 696) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2026-09-23 |