| NPI | 1043300130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2082) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC37667) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-07-22 |