| NPI | 1245625144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111668) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF69752) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2020-09-23 |