| NPI | 1043769672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111649) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT111649) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2019-11-05 |