| NPI | 1235653668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT124014) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 100022) |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF100022) | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2021-10-15 |