| NPI | 1871047597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF 75331) | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2023-04-24 |