| NPI | 1831496439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1488) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 61621) |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2019-08-12 |