| NPI | 1457533630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT87428) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 45168) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2019-03-11 |