| NPI | 1063218790 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 149643) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 17455) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-02-24 |