| NPI | 1457694374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 84322) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-02-11 |