| NPI | 1750714796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 99388) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83012) |
| 106H00000X Marriage & Family Therapist (Licence: CA 83012) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2018-03-17 |