| NPI | 1316145360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 49109) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA Intern # 51561) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-12-30 |