| NPI | 1720746746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 128885) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2025-05-13 |