| NPI | 1679591465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC19830) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0295) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-09 |