| NPI | 1487961637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 94486) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2020-08-24 |