| NPI | 1083158117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT11072) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LMFT110742) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2021-02-11 |