| NPI | 1164864104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 109827) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 76736) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2024-05-17 |