| NPI | 1093939597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-6603) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT 2906) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-12-11 |