| NPI | 1265576813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 115403) |
| 106H00000X Marriage & Family Therapist (Licence: CA 76536) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2021-08-11 |