| NPI | 1578179537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS T10693) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002509) |
| 106H00000X Marriage & Family Therapist (Licence: KS 03309) | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2025-04-02 |