| NPI | 1366658825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: DE 0000002) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001110) |
| 106H00000X Marriage & Family Therapist (Licence: PA MF000287) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-03-08 |