| NPI | 1235649047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 132329) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 76285) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2023-04-13 |