| NPI | 1164690558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 62700) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2015-04-06 |