| NPI | 1053884395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA amft109118) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106H00000X Marriage & Family Therapist (Licence: CA amft109118) | |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-02-04 |