| NPI | 1962483313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 1379) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1279) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2024-03-27 |