| NPI | 1124409834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61371468) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101007567) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2026-01-15 |