| NPI | 1730306259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0700) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA 60540107) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-09-23 |