| NPI | 1225381874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM CTB-2022-0082) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NE 1417) |
| 106H00000X Marriage & Family Therapist (Licence: IA 076846) | |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2023-12-05 |