| NPI | 1275316382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 2329-124) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1061-228) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2025-04-30 |