| NPI | 1144585464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35002036A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006591) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2021-01-18 |