| NPI | 1457559676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2018) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 51474) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2019-05-17 |