| NPI | 1205133808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 63660) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 53530) |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2022-07-21 |