| NPI | 1497164123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LMFT109797) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 78065) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2018-12-17 |