| NPI | 1184973992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 95851) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA 74879) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2022-02-11 |