| NPI | 1942439302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 4520) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1309) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2010-11-12 |