| NPI | 1699831263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 21005) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 2100005MFC) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-09-21 |