| NPI | 1124595871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT15377) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT001648) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2022-04-26 |