| NPI | 1487347514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 152424) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT131915) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2025-01-08 |