| NPI | 1316498652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC49499) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 1277) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |