| NPI | 1710238084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 65631) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 94788) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2021-04-28 |