| NPI | 1598258584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 140538) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 108620) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-11-08 |