| NPI | 1376821074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC49986) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC327) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2014-07-21 |