| NPI | 1265508121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 40764) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 40764) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2019-12-10 |