| NPI | 1952779423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0173671) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT11894) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |