| NPI | 1306374947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 11985) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 11985) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2025-12-10 |