| NPI | 1770161572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 20067) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT3609) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-06-02 |