| NPI | 1063021996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 17248) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2025-10-30 |