| NPI | 1922763945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2558) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 12355A) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2023-11-27 |