| NPI | 1518382266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS T01815) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MS w2000) |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2024-06-11 |