| NPI | 1386102333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144222) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2024-05-17 |