| NPI | 1871538306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 48588) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA PSB31462) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2010-08-31 |