| NPI | 1356806392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS T10526) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 104846573904) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2023-05-10 |