| NPI | 1750544375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1361) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1088) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2011-03-21 |