| NPI | 1912592403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2022-08-15 |