| NPI | 1104170133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 19873) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC 11) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-10-29 |