| NPI | 1790042190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT105005) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF70106) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2019-02-11 |