| NPI | 1720292568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 104386) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 69112) |
| 101YM0800X Counselor, Mental Health (Licence: CA PT28111) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2022-01-19 |