| NPI | 1134621485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 119196) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 102487) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2020-06-24 |