| NPI | 1891960845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WY PMFT #238) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS LMFT#951) |
| 106H00000X Marriage & Family Therapist (Licence: NE PLMHP #8586) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2010-01-12 |