| NPI | 1174049035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 128805) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 10904) |
| 101YM0800X Counselor, Mental Health (Licence: CA 5890) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2021-12-21 |