| NPI | 1619280351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT86906) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF69036) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2015-07-25 |