| NPI | 1871244137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 3959) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 001960-01) |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2024-10-01 |