| NPI | 1124675293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 2392) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2024-11-11 |