| NPI | 1851709935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 71811) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 71811) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2015-10-26 |