| NPI | 1083305064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 156975) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 138787) |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2025-08-17 |