| NPI | 1164757605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 101500) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF#61749) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2021-03-13 |