| NPI | 1497288070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 8163) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT 3322) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2026-10-14 |