| NPI | 1134883119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 152142) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2025-02-03 |