| NPI | 1053564294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ME mf5229) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 28644) |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2023-06-30 |