| NPI | 1912303025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2162) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 131367) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2023-02-28 |