| NPI | 1710317615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35002025A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT001317) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2018-08-27 |