| NPI | 1518528983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 137730) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 111310) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2023-02-13 |