| NPI | 1699328641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 152378) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2026-07-31 |