| NPI | 1861480659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT0388) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC0131) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2020-11-20 |