| NPI | 1710117882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT47075) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA LPCC 1622) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2017-03-12 |