| NPI | 1063877926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 133233) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2015-12-19 |
| Last Update Date | 2024-06-19 |