| NPI | 1295273449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 100626) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PCCI 2117) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2017-08-10 |