| NPI | 1083024814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 95111) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 76484) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2022-05-09 |