| NPI | 1679849566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA M24381) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-15531) |
| 106H00000X Marriage & Family Therapist (Licence: OR T3084) | |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2025-10-20 |