| NPI | 1972067577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-15661) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 5322474-3902) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2024-06-09 |