| NPI | 1699922393 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: HI 356) | 
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NV 5106-R) | 
| Enumeration Date | 2008-08-25 | 
| Last Update Date | 2025-08-14 |