| NPI | 1992913099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA MFT 403) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 3057) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-01-18 |