| NPI | 1912379793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 104536) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 78057) |
| 106H00000X Marriage & Family Therapist (Licence: CA 78057) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2021-07-13 |