| NPI | 1053885756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2018038889) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2021-06-15 |