| NPI | 1851561393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 4564) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 30357) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2014-02-04 |