| NPI | 1134792047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 147311) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 127005) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2024-08-20 |