| NPI | 1245992254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 137426) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-01-27 |