| NPI | 1801103700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT116970) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT35083) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2024-06-17 |