| NPI | 1932408390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 99403) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT4352) |
| 106H00000X Marriage & Family Therapist (Licence: ID 7671249) | |
| 106H00000X Marriage & Family Therapist (Licence: UT 10915564-3902) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2025-04-08 |