| NPI | 1831642792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111800) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 92048) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2019-02-17 |