| NPI | 1710052642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA MFT363) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LCSW200877) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2025-09-11 |