| NPI | 1720412612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 114081) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 74935) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2024-07-17 |