| NPI | 1356836597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NH 293) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1861) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2023-03-10 |