| NPI | 1841603180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001505) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN 1010) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2023-07-24 |