| NPI | 1467878173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA lMF 72130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF72130) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2020-03-27 |