| NPI | 1316360670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2021023240) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2019041060) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2025-10-21 |