| NPI | 1609134691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AMFT114439) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT114439) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2020-12-21 |