| NPI | 1487666186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122872) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 1016) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-05-24 |