| NPI | 1063960250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2213) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 77588) |
| 106H00000X Marriage & Family Therapist (Licence: CA 104774) | |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2024-01-01 |