| NPI | 1730244070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-5324T) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 368850-3902) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2013-04-29 |