| NPI | 1912310137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 79596) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MT 50740) |
| 106H00000X Marriage & Family Therapist (Licence: ID 8327) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2026-04-24 |