| NPI | 1508943549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 50758) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH5482) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-11-22 |