| NPI | 1801434345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 127621) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 111294) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2025-02-21 |