| NPI | 1023428117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT138474) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 103K00000X Behavior Analyst | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF61658464) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2025-04-03 |