| NPI | 1902023286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker (Licence: CA MFT78459) | |
| 106H00000X Marriage & Family Therapist (Licence: CA IMFT78459) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2018-08-10 |