| NPI | 1174802599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT94478) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 71302) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2019-03-11 |