| NPI | 1366011934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101007159) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NV 01336) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2022-08-03 |