| NPI | 1346368891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 49638) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 53157) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-06-01 |