| NPI | 1023748548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2585) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 12425A) |
| 106H00000X Marriage & Family Therapist (Licence: NC 12425A) | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-08-21 |