| NPI | 1053862136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 97638) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF73908) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2017-01-05 |