| NPI | 1225620966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MK61645925) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 12868160-3902) |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2025-05-07 |