| NPI | 1255888707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 104648) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFTI86317) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-04-05 |