| NPI | 1780058131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105283) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 89979) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2021-07-01 |