| NPI | 1730297425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: HI MFT161) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT24240) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |