| NPI | 1700252673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2020-03-16 |