| NPI | 1174649610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT50145) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 32906) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2021-10-11 |