| NPI | 1073284485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT126893) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC61202720) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2021-09-24 |