| NPI | 1417333204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 31) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 50646) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |