| NPI | 1962934257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 114768) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF98305) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2020-11-09 |