| NPI | 1740547256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA IMF 77287) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2014-03-03 |