| NPI | 1821301128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 92768) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 69915) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2020-06-16 |