| NPI | 1043968134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 142104) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 15803) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2024-04-01 |