| NPI | 1285959189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 43050) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: CA SC 82671) |
| 101YP2500X Counselor Professional (Licence: CA 878) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2014-03-06 |