| NPI | 1861720740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 32411) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NE LIMHP 340) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2014-03-14 |