| NPI | 1710177498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 50427) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF51739) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2021-04-22 |