| NPI | 1447024930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2024-07-24 |