| NPI | 1265796817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 454) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 15091) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2012-06-28 |