| NPI | 1982125381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131868) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E.2102511) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2022-07-05 |