| NPI | 1841487642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1527) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 106H00000X Marriage & Family Therapist (Licence: SC 4536) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2013-09-18 |