| NPI | 1447733134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 107685) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2019-04-29 |