| NPI | 1427176213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 85178) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF72871) |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF51969) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-11-07 |