| NPI | 1891391645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 4544) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1436) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2021-05-12 |