| NPI | 1609324128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 4425) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA 082182) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2023-03-20 |