| NPI | 1912646308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: DE FT-0010116) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 277781) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2023-07-05 |