| NPI | 1417509589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: HI 616) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: HI MHC-600) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2025-11-17 |