| NPI | 1861846040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT 17382) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MT 23019) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-12-21 |