| NPI | 1558019588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 12737565-3902) |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2024-10-21 |