| NPI | 1457674707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2020-04-15 |