| NPI | 1063167765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129320) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 002277) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2024-06-10 |