| NPI | 1407126139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 108727) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 106H00000X Marriage & Family Therapist (Licence: CA 74215) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2019-10-24 |