| NPI | 1215695440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 7988) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15635) |
| 106H00000X Marriage & Family Therapist (Licence: NC 2253) | |
| Enumeration Date | 2021-12-05 |
| Last Update Date | 2024-01-12 |