| NPI | 1730616137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID 4071084) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT4384) |
| 106H00000X Marriage & Family Therapist (Licence: OR T1889) | |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2026-07-06 |