| NPI | 1225780125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2476) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 12387A) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-12-27 |