| NPI | 1326519505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 150325) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 110706) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2026-05-29 |