| NPI | 1497962476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF-60253) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-08-31 |