| NPI | 1790113058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 95962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 74910) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2021-03-30 |