| NPI | 1245462902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 85905) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFTI#60154) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2020-07-22 |