| NPI | 1396227955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1862) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 12826) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2024-04-16 |