| NPI | 1104160050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1029) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC41926) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2019-02-15 |