| NPI | 1174381396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| 102L00000X Psychoanalyst | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2025-09-21 |