| NPI | 1477807717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 46911) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 4891) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |