| NPI | 1750674388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106H00000X Marriage & Family Therapist (Licence: CA 61914) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2021-06-17 |