| NPI | 1689197857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 113269) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 113269) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2020-01-23 |