| NPI | 1902780182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 138907) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0003161) |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2026-05-20 |