| NPI | 1700752615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VT 100.0134271) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AL 636) |
| 106H00000X Marriage & Family Therapist (Licence: WA 61586953) | |
| Enumeration Date | 2025-10-16 |
| Last Update Date | 2025-10-16 |