| NPI | 1629099189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1114) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 40935) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-09 |