| NPI | 1629370010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 65280) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 202763) |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2021-03-11 |