| NPI | 1457603417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT 1712) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2015-02-20 |