| NPI | 1083998454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 98269) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 4378) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2019-02-25 |