| NPI | 1902165830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 70980) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2016-03-09 |