| NPI | 1477669679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 44306) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001864) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-03-25 |