| NPI | 1003783705 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 155197) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 19505) |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-20 |