| NPI | 1124428446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA LMFT10000164) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NM CMF0194021) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2026-02-25 |