| NPI | 1174904262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1217) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AL 423) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2024-08-06 |