| NPI | 1972958601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MT 71) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1736) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-06-04 |