| NPI | 1255472320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60229702) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC45852) |
| 251S00000X Community/Behavioral Health (Licence: CA MFC45852) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2022-10-03 |