| NPI | 1114649241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MD LCM1044) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MD LGM902) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2024-10-08 |