| NPI | 1609955699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT109669) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC6769) |
| 1710I1002X Military Health Care Provider, Independent Duty Corpsman | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2021-10-28 |