| NPI | 1457405078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: DC MFT0000153) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC41512) |
| 101YP2500X Counselor, Professional (Licence: MD LC5169) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2013-07-16 |