| NPI | 1629119946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 49444) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94020289) |
| 106H00000X Marriage & Family Therapist (Licence: CA 47431) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2022-04-22 |