| NPI | 1992007710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 113095) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA CO004912) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2024-01-05 |