| NPI | 1558792473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 96859) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 75986) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2022-09-15 |