| NPI | 1982832135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001277) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 000734-1) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2018-03-21 |