| NPI | 1952467961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA 517) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 9024) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |