| NPI | 1386088771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 106405) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 70664) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2018-07-09 |