| NPI | 1730430075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001414) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2021-02-06 |