| NPI | 1376882381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2211) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 90115) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2023-12-08 |