| NPI | 1790815876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT6888) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC40112) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2019-04-11 |