| NPI | 1821675810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 132223) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2022-09-19 |