| NPI | 1174791354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MD LCM850) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 100802) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2025-05-15 |