| NPI | 1871643643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 1389) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN 605) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2015-10-26 |