| NPI | 1588030522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105525) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF#87741) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2020-06-17 |