| NPI | 1285002725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3937) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 63072) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2022-02-02 |