| NPI | 1023419256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1774) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001803) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2025-06-02 |