| NPI | 1770994147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 252114) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 86441) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2021-06-02 |