| NPI | 1831505247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122154) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 104078) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2024-07-09 |