| NPI | 1083799050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 3518) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT000966) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2018-03-16 |