| NPI | 1245663616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 100636) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF#71962) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2018-06-06 |