| NPI | 1003682857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 157231) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2025-08-18 |