| NPI | 1902083470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA 60680360) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 79840) |
| 106H00000X Marriage & Family Therapist (Licence: TX 202440) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2023-12-14 |