| NPI | 1205103082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT 83803) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60064964) |
| 101YP2500X Counselor, Professional (Licence: CA LPCC 162) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2016-08-03 |