| NPI | 1487946133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2049) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2022-05-31 |