| NPI | 1487839775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 77140) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 54321) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2018-09-18 |