| NPI | 1508184300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA lcs11405) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA mfc18532) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2011-07-01 |