| NPI | 1194266510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 14521) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 1910) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2019-06-10 |