| NPI | 1083785836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-1515) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT39787) |
| 106H00000X Marriage & Family Therapist (Licence: OR T1066) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2017-03-20 |