| NPI | 1598047565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA LMFT99064) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT99064) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2018-09-25 |