| NPI | 1174876163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 99203) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 99203) |
| 106H00000X Marriage & Family Therapist (Licence: CA 72142) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2022-10-02 |