| NPI | 1710596267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 3173) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL TPMF644) |
| 106H00000X Marriage & Family Therapist (Licence: LA 1517) | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2023-09-14 |