| NPI | 1053793224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124122) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA imf 91678) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-03-12 |