| NPI | 1114347028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 106865) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 89494) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2019-07-24 |