| NPI | 1447787965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122928) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 122928) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2021-11-11 |