| NPI | 1770664526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX 05-060-B (TEA)) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 2646) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2025-09-11 |