| NPI | 1013388800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF87170) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA PCCI2215) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |