| NPI | 1649657149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG60467470) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LAMFT-5546T) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2019-10-31 |