| NPI | 1134805948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 2798) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 2049-124) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |