| NPI | 1255539979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1011) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 47192) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2015-08-17 |