| NPI | 1972809523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV MI0839) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2011-01-30 |
| Last Update Date | 2018-03-17 |