| NPI | 1922017573 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35001484A)  | 
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 646)  | 
| Enumeration Date | 2006-08-05 | 
| Last Update Date | 2008-10-17 |