| NPI | 1083155105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122229) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2021-07-11 |