| NPI | 1952931891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MD LCM754) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT111604) |
| Enumeration Date | 2020-01-20 |
| Last Update Date | 2020-02-14 |