| NPI | 1548396302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0622) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 41486) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2008-12-03 |