| NPI | 1073242541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 159632) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2026-01-29 |