| NPI | 1467847038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1967) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 10036A) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2019-01-17 |