| NPI | 1114306149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 120570) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 96903) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2020-08-06 |