| NPI | 1275298416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2022-06-06 |