| NPI | 1013970755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 105259) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35002076A) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-11-08 |