| NPI | 1154609246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3719) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 103171) |
| Enumeration Date | 2011-07-24 |
| Last Update Date | 2019-10-30 |