| NPI | 1780202242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 149344) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2024-10-21 |