| NPI | 1972768463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 90970) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 57114) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2016-01-11 |