| NPI | 1407310840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136997) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 204954) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2025-12-29 |