| NPI | 1174366504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 2514) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-08-13 |