| NPI | 1083726418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 13259) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA CRC1866) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-10-02 |