| NPI | 1528535226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 4705) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1460) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2018-10-31 |