| NPI | 1376346056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717002631) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF001890) |
| 106H00000X Marriage & Family Therapist (Licence: CO MFT.0003103) | |
| 106H00000X Marriage & Family Therapist (Licence: SC LMF.8383MFT) | |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2026-08-02 |