| NPI | 1689228637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 141099) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 114221) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2024-02-14 |