| NPI | 1528303930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 90072) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA 90072) | |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2015-11-05 |