| NPI | 1780164897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA 001627) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 106511) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |