| NPI | 1215292461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 982) |
| Additional Taxonomies | 101Y00000X Counselor |
| 102L00000X Psychoanalyst | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2018-04-26 |