| NPI | 1174720478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 42542) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 201032) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2016-05-24 |