| NPI | 1609249937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001404) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 344780-3902) |
| 106H00000X Marriage & Family Therapist (Licence: CA 70174) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2018-07-13 |