| NPI | 1265619852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 100644) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 72448) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2019-08-06 |