| NPI | 1255764627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 98495) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2018-07-23 |