| NPI | 1114774593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T3436) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002609) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2025-12-03 |