| NPI | 1609192038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129847) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor Mental Health (Licence: CA 129847) | |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2024-07-01 |