| NPI | 1720456635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1903) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 78208) |
| 106H00000X Marriage & Family Therapist (Licence: WA LF60817829) | |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2024-03-01 |