| NPI | 1578904561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AR M1901001) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT001418) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2022-02-21 |