| NPI | 1619091121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 40036) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC40036) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-05-06 |