| NPI | 1033995246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 372198) |
| Additional Taxonomies | 101200000X Drama Therapist |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2024-12-23 |