| NPI | 1891657540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0990) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 41784) |
| Enumeration Date | 2025-12-02 |
| Last Update Date | 2025-12-02 |