| NPI | 1588142624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124504) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT104622) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2021-02-23 |