| NPI | 1043688906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT154512) |
| Additional Taxonomies | 103T00000X Psychologist |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2025-08-26 |