| NPI | 1780278143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 35208) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2022-02-04 |