| NPI | 1568999621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 128308) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 99662) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2023-04-12 |