| NPI | 1689929572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130553) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106H00000X Marriage & Family Therapist (Licence: CA 109059) | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-06-02 |