| NPI | 1093053506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT103991) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301014421) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2019-03-16 |