| NPI | 1417004649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC34449) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 321825) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-07-08 |