| NPI | 1477928562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129229) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 123981) |
| 106H00000X Marriage & Family Therapist (Licence: CA 84202) | |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2021-11-16 |