| NPI | 1760823439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 106529) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: imf75107) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2022-09-22 |