| NPI | 1659789071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 82294) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: 82294) |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-11-14 |