| NPI | 1023158839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 65892) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 47276) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2011-05-04 |