| NPI | 1891224283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 6995) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1746) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |