| NPI | 1063938066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 4099) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF83061) |
| 106H00000X Marriage & Family Therapist (Licence: CA 111496) | |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2023-05-29 |