| NPI | 1871820779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC #46047) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA MFC #46047) |
| 102L00000X Psychoanalyst (Licence: CA MFC #46047) | |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2016-05-23 |