| NPI | 1548849896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID 7761369) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2024-11-14 |