| NPI | 1164567459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA LMFT1365) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 106H00000X Marriage & Family Therapist (Licence: NC 6098A) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-01-04 |