| NPI | 1144680513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105919) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 203918) |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2026-02-09 |