| NPI | 1114466877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF96282) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF96282) |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT127960) | |
| 101YM0800X Counselor, Mental Health (Licence: CA LMFT127960) | |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2022-01-06 |