| NPI | 1164570875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 005108-005758) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC34805) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |