| NPI | 1104204593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 115298) |
| 101Y00000X Counselor | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2020-01-17 |