| NPI | 1144609819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 101267) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA 101267) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2019-04-15 |