| NPI | 1417164922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN LMT758) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH F0500021) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2009-09-02 |