| NPI | 1710423504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 92984) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 92984) |
| 101YM0800X Counselor Mental Health (Licence: CA 92984) | |
| 101YP1600X Counselor Pastoral (Licence: CA 92984) | |
| 101YP2500X Counselor Professional (Licence: CA 92984) | |
| 106S00000X Behavior Technician (Licence: CA 92984) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |