| NPI | 1083967442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1282) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF60724149) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2021-12-21 |