| NPI | 1144588708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-7120) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 8324338-3902) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006429) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF60462315) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2019-08-26 |