| NPI | 1184942872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 91005) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 62431) |
| 106H00000X Marriage & Family Therapist (Licence: CA 62431) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2018-06-13 |