| NPI | 1538047907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 8706) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 005796) |
| 106H00000X Marriage & Family Therapist (Licence: SC 7961) | |
| 106H00000X Marriage & Family Therapist (Licence: GA 001180) | |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-08-25 |