| NPI | 1780142901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001647) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2017039379) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2020-11-24 |