| NPI | 1134684335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT123851) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT110915) |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2021-01-21 |