| NPI | 1598950107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111899) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA 63057) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 92081) | |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2021-07-03 |