| NPI | 1659708758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 118510) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2020-05-26 |