| NPI | 1205492907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 11850) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166001348) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717001774) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2026-04-14 |