| NPI | 1568885192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 100111) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 71325) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2018-07-30 |