| NPI | 1114324167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112495) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT112495) |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2020-01-08 |