| NPI | 1770647158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 104737) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT-104737) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-04-07 |