| NPI | 1003344995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122270) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 108481) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 108481) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 108481) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2025-12-01 |