| NPI | 1083255798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 9597) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 125841) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2024-04-19 |