| NPI | 1184157281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 113657) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 98278) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2021-06-14 |