| NPI | 1609215243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 113608) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2024-05-15 |