| NPI | 1962814608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2228) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 124488) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2021-09-27 |