| NPI | 1912914961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 38188) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-05-19 |