| NPI | 1285095638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 83524) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 83524) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-03-18 |