| NPI | 1720409329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LMFT121679) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF80378) | |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC121679) | |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2022-11-08 |