| NPI | 1306050158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0090501) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 41945) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-09 |