| NPI | 1568105153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 2367) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-16034) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-07-02 |