| NPI | 1194071068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-7127) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LAMFT - 4656) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2022-06-20 |