| NPI | 1891847307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA IMF56524) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF # 56524) |
| 101YM0800X Counselor, Mental Health (Licence: RI 391) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2011-01-14 |