| NPI | 1053942862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 128700) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 108633) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2024-02-22 |