| NPI | 1184916231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA MFT1109) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT 2423) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2020-04-03 |