| NPI | 1588090542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 104324) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 225400000X) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2021-03-23 |