| NPI | 1174682041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VT 100-0000053) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 1999139249) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2011-02-16 |