| NPI | 1518256189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0563) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 27681) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |