| NPI | 1417016247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 44475) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 30405) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2018-08-08 |