| NPI | 1457447765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 459) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 503) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2010-03-29 |