| NPI | 1184788200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 48353) |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF 45355) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-06-01 |