| NPI | 1043652944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA IMF89161) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF89161) | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2022-01-04 |