| NPI | 1447790464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 88356) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 88356) |
| 101YM0800X Counselor, Mental Health (Licence: CA 88356) | |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2017-08-02 |