| NPI | 1902001027 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 18097) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA LEDPSY901) |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT2624) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2012-12-03 |