| NPI | 1962522086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VT 100-0000054) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 44173) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2023-09-04 |