| NPI | 1104283704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1072-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 88717) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2023-08-23 |