| NPI | 1508200114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124722) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT3614) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2024-12-13 |