| NPI | 1306977392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 44697) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003891) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2008-07-30 |