| NPI | 1619031390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ME MF5421) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NH EL0320) |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT-8157) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-07-05 |