| NPI | 1285886440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 48847) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 1380) |
| 101YP2500X Counselor, Professional (Licence: VA 0701004454) | |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-01-28 |