| NPI | 1952828535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2024-04-29 |