| NPI | 1023637782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 12130A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 2111) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-04-27 |