| NPI | 1699476903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WV 913) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH M.2400309) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2025-04-01 |