| NPI | 1629595921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2122) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 12054A) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2020-06-17 |