| NPI | 1467937730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 117272) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 79158) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2020-04-29 |