| NPI | 1639378524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2023003157) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 236) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2023-02-08 |