| NPI | 1952461675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0087631) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA mfc15978) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2009-05-20 |