| NPI | 1053880591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 141170) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 109377) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2024-05-07 |