| NPI | 1740569433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 1421) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7726) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2024-02-04 |