| NPI | 1770672362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 84277) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 49658) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-05-31 |