| NPI | 1154874915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 115650) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF87443) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2019-09-30 |