| NPI | 1407137078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 102242) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 73667) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2018-03-17 |