| NPI | 1902003619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0552) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC41327) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2015-07-07 |