| NPI | 1306128681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT97196) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 68657) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2017-01-06 |