| NPI | 1629197728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 83995) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 64694) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2023-09-08 |