| NPI | 1023437084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2023035078) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P2211001) |
| 106H00000X Marriage & Family Therapist (Licence: AR M2211000) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2023-10-04 |