| NPI | 1013091495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 01478) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0376) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-04-01 |