| NPI | 1639550338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NH 58) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NH 28348) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2015-06-18 |