| NPI | 1629563713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135127) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 108790) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2022-11-17 |