| NPI | 1598124273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ 10452) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ 16106) |
| 106H00000X Marriage & Family Therapist (Licence: AL 193) | |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2025-03-06 |