| NPI | 1639597453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 10987) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 42189) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2026-08-13 |