| NPI | 1528202207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 59828) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor Mental Health (Licence: CA 59828) | |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2014-04-05 |