| NPI | 1114413952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 133351) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 105711) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2025-08-13 |