| NPI | 1629447974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124856) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 85252) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2021-03-11 |