| NPI | 1477954394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 109777) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 73494) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2022-08-23 |