| NPI | 1083193361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 156848) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 20056) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-09-08 |