| NPI | 1053922252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 120437) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 133008) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2022-08-18 |