| NPI | 1013422005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129096) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 101337) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2022-12-13 |