| NPI | 1932240116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 18207) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA MFT18207) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2008-09-16 |