| NPI | 1093934952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1639) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M0610008) |
| 106H00000X Marriage & Family Therapist (Licence: UT 5264830-3902) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2015-06-18 |