| NPI | 1780910752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 6967) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: HI 182) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2024-02-07 |