| NPI | 1790962397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT #001285) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2012-10-10 |