| NPI | 1952673402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LMFT48473) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0799) |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT48473) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2024-04-10 |