| NPI | 1194126763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131261) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 108587) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2014-09-14 |
| Last Update Date | 2022-05-20 |