| NPI | 1639506629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1723) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 93170) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2023-10-11 |