| NPI | 1477802171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT132596) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA IMF98796) |
| 101YM0800X Counselor Mental Health (Licence: CA IMF98796) | |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2022-06-06 |