| NPI | 1205958204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 4657) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 802) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2010-02-16 |