| NPI | 1104073501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC51368) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2012-10-17 |