| NPI | 1922862507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID 2871447) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 12439475-3904) |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2025-04-14 |