| NPI | 1487781555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 50170) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: CA 50170) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2018-03-17 |