| NPI | 1578925574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135034) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF91713) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2023-06-14 |