| NPI | 1245755586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124459) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 95307) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2021-02-22 |