| NPI | 1487912028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 67977) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 65688) |
| 101YP2500X Counselor Professional (Licence: CA 425) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2013-11-14 |