| NPI | 1568232791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |