| NPI | 1649855198 |
|---|---|
| Former Name | MELISSA MARIE MCCORMICK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2022-09-22 |