| NPI | 1750850004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124516) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 108125) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2021-05-27 |