| NPI | 1114282035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 80303) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF63514) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2016-07-17 |