| NPI | 1548603368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112234) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 74125) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-07-02 |