| NPI | 1750606091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0689) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 117052-3902) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |