| NPI | 1851783757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF82380) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2016-09-07 |