| NPI | 1982269726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 149318) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 108874) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2026-10-12 |