| NPI | 1265500193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 62230) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 89431) |
| 106H00000X Marriage & Family Therapist (Licence: CA 44695) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-10-02 |