| NPI | 1639395429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1531) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 63282433904) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2013-11-13 |