| NPI | 1023606027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 3884) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002492) |
| 106H00000X Marriage & Family Therapist (Licence: UT 13663575-3902) | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2023-11-08 |