| NPI | 1003049560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 44200) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2025-09-08 |