| NPI | 1972389567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143377) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-12-22 |