| NPI | 1851830293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT77728) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LMFT77728) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |