| NPI | 1760954325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 150759) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT110158) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2026-03-24 |