| NPI | 1518279645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 53034) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 62272) |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor Mental Health (Licence: CA 70137) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2014-11-21 |