| NPI | 1699143636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 88845) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT3955) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2024-08-08 |