| NPI | 1184649451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT021168) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT 3813) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |