| NPI | 1770137879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135651) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT111750) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2022-12-16 |