| NPI | 1124872429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT49803) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0001605) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |