| NPI | 1396110391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LMFT16179) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA LMFT16179) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2016-04-21 |