| NPI | 1083190185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA 107910) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2023-05-09 |