| NPI | 1487149704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1678) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 2872) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-07-08 |