| NPI | 1073795092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 48326) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 12588355-3902) |
| 106H00000X Marriage & Family Therapist (Licence: ID 8820) | |
| 106H00000X Marriage & Family Therapist (Licence: OR T2167) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2026-01-24 |