| NPI | 1982272910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122128) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CA 122128) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2023-04-13 |