| NPI | 1164934139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AL L576) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 10085308-3904) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2023-02-01 |