| NPI | 1932676061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4151001073) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60823575) |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2025-04-15 |