| NPI | 1265791859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 42673) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1065) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2012-05-16 |