| NPI | 1114167731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AR M1205005) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P1205057) |
| Enumeration Date | 2009-02-21 |
| Last Update Date | 2012-06-26 |