| NPI | 1649440397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT 1222) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 1222) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2008-05-05 |