| NPI | 1770816209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 88338) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 60710) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2015-12-08 |