| NPI | 1063981496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 128069) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC5698) |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT109657) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2021-09-17 |