| NPI | 1679853709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: DC LMFT000141) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT1202) |
| 106H00000X Marriage & Family Therapist (Licence: MA MF1342) | |
| Enumeration Date | 2011-08-20 |
| Last Update Date | 2011-08-20 |