| NPI | 1891206603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 93475) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 106H00000X Marriage & Family Therapist (Licence: NY 001694) | |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2020-09-29 |