| NPI | 1043759012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF91919) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA PCCI2748) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2017-02-23 |