| NPI | 1700963873 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT 2585) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: CA 6975) |
| 101YP2500X Counselor, Professional (Licence: MT 30490) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 40700) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2018-11-20 |