| NPI | 1568879880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 6993) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 2567) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2023-02-22 |