| NPI | 1225761505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2024044441) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2022016442) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2025-08-12 |