| NPI | 1508118100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0797) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 25660) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2021-04-20 |