| NPI | 1700391976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112933) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 102662) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2019-04-29 |