| NPI | 1164559647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA MFT#37092) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT37092) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2009-06-16 |