| NPI | 1396974788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 82205) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 67175) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2017-11-06 |