| NPI | 1669643722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 108062) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA 76672) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2018-08-13 |