| NPI | 1154061455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 139125) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2024-01-04 |