| NPI | 1265934301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 140440) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 101492) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2023-08-18 |