| NPI | 1073004396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 109099) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 90170) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-09-25 |