| NPI | 1770851529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001326) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT2863) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2017-10-30 |