| NPI | 1174788939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS TO366) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS TO 366) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2011-06-08 |