| NPI | 1700389608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2022011310) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 03120) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2022-11-16 |