| NPI | 1003934332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT84352) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF49635) | |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF69043) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-01-14 |