| NPI | 1568141893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-15432) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LMFT-15432) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2023-09-28 |