| NPI | 1104140854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-0325) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-0829) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2010-03-24 |