| NPI | 1952701732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT138254) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH12762) |
| 101YM0800X Counselor, Mental Health (Licence: CA LPCC8490) | |
| 106H00000X Marriage & Family Therapist (Licence: FL MT3972) | |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2023-03-03 |