| NPI | 1578839049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0827) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 4813116-3902) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2022-07-21 |