| NPI | 1821515487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 121218) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 101129) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2024-07-05 |