| NPI | 1780712661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT2233) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC35884) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-04-14 |