| NPI | 1972873834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 91310) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 73749) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2018-04-10 |