| NPI | 1104299015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT109665) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PCCI 2356) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2018-10-01 |