| NPI | 1992928394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: ID LMFT-2687) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-2687) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2012-09-20 |