| NPI | 1083355390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131179) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 11165) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2022-08-12 |