| NPI | 1346763919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111109) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 14227392-3902) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717002377) | |
| 106H00000X Marriage & Family Therapist (Licence: AZ 15608) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2025-08-05 |