| NPI | 1689972051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 81928) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 58802) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2015-11-04 |