| NPI | 1194863027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 115534) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 7653) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-03-12 |