| NPI | 1366952962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 71850) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2017-10-13 |