| NPI | 1073659801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 229-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 00170) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |