| NPI | 1982918744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 107983) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 55060) |
| 106H00000X Marriage & Family Therapist (Licence: TN 2541) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2025-04-16 |