| NPI | 1538395462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124066) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA AMFT104781) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2021-05-04 |