| NPI | 1083636518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-15) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC-2666) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-12-30 |