| NPI | 1528332756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA Mft35108) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2015-10-19 |