| NPI | 1437201993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0751) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T0389) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2018-04-14 |