| NPI | 1639574015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 97556) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 81305) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2021-03-02 |