| NPI | 1932813060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: HI 808) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: HI MFT-808) |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2025-02-18 |