| NPI | 1336739937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM CMF0067452) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT25725) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-01-19 |