| NPI | 1528023686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001207) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 6074027-3902) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2010-01-21 |