| NPI | 1295768380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 182) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 2930) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2007-07-08 |