| NPI | 1942784137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NH 241) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1712) |
| 106H00000X Marriage & Family Therapist (Licence: RI 00195) | |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2022-08-22 |