| NPI | 1225218969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 93434) |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist (Licence: CA 62636) | |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2018-05-08 |