| NPI | 1407494941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112501) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 112501) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2022-06-14 |