| NPI | 1235256207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 36032) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT 17535) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |