| NPI | 1174180111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1674) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2025-01-15 |