| NPI | 1295832095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 7960) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA Mf000217) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-10-18 |