| NPI | 1073119764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT 2831) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2026-06-25 |