| NPI | 1639457823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 5343) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL IMT1490) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2012-02-15 |