| NPI | 1801027933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT131101) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2022-08-02 |