| NPI | 1154632206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1242) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 48474) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2017-02-10 |