| NPI | 1689087884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: 107499) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 75759) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2022-11-22 |