| NPI | 1578973384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 170794) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NM CMF0210941) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2023-12-15 |