| NPI | 1467715672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2013-12-30 |