| NPI | 1427057579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0815) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT000940) |
| 106H00000X Marriage & Family Therapist (Licence: TN 845) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2022-03-11 |