| NPI | 1255748802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 109967) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 4609) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2024-09-07 |