| NPI | 1114227055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID 10405) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD 1228) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2024-08-13 |