| NPI | 1407560444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 137390) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2023-01-25 |