| NPI | 1124590484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 15702) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 15702) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2024-02-26 |