| NPI | 1568892297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124038) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 205089) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2023-07-01 |