| NPI | 1316485568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 100630) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 75196) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2023-12-19 |