| NPI | 1134896830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI pending) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 803228) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-11-29 |