| NPI | 1033432786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2010004312) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 773) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2021-04-05 |