| NPI | 1316477367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 134239) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 117625) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-12-20 |