| NPI | 1215460720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105468) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 105468) | |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 727109) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2018-04-19 |