| NPI | 1104512607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 130164) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2024-03-22 |