| NPI | 1043761638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 117784) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA PCCI 3264) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2020-04-02 |