| NPI | 1841472016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 49065) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: CA IMF 45108) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2023-10-24 |