| NPI | 1619008943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2065) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC43897) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2026-07-21 |