| NPI | 1760200802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2024-09-27 |