| NPI | 1588829022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1382) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1352) |
| 106H00000X Marriage & Family Therapist (Licence: FL 1861) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2011-08-04 |