| NPI | 1104245133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 103787) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 73218) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2017-12-23 |