| NPI | 1003634197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 164502) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-09-28 |
| Last Update Date | 2026-08-30 |