| NPI | 1033808639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 142409) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2024-07-24 |