| NPI | 1659809655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 96882) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD 11525) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2021-03-26 |