| NPI | 1518592252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV MI4311) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2025-01-16 |