| NPI | 1215413703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2575) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 124713) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2026-04-30 |