| NPI | 1861852402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112174) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA LCI04481015) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2020-06-05 |