| NPI | 1831652213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 53274) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101007678) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2026-08-26 |