| NPI | 1104330406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111230) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF82844) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2020-05-19 |