| NPI | 1851503049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-4766) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH F0600002) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-10-05 |