| NPI | 1194446096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AR M2408001) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001485) |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2026-01-15 |