| NPI | 1992036172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 64499) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2013-07-17 |