| NPI | 1629157896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ 0071) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-26 |