| NPI | 1558798157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA IMF 66700) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA IMF 66700) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFTI IMF 66700) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2014-12-23 |