| NPI | 1194266130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT111380) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT88636) |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF88636) | |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2020-01-07 |