| NPI | 1164196770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MD LCM959) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MD LGM835) |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2023-06-29 |