| NPI | 1245060219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 19) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 120) |
| 103T00000X Psychologist (Licence: AR 86-12P) | |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-05 |