| NPI | 1164791075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 94423) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF#67534) |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF#67534) | |
| 225400000X Rehabilitation Practitioner (Licence: CA IMF# 67534) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2022-08-08 |