| NPI | 1730300070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 46939) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 80563) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2025-02-19 |