| NPI | 1669061776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001209) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 22059) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2021-01-13 |