| NPI | 1073089314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129954) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2018-10-14 |
| Last Update Date | 2022-01-14 |