| NPI | 1013162080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 53822) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 52952) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2014-03-20 |