| NPI | 1083296719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143846) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 125409) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2024-04-25 |