| NPI | 1104593250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 127546) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 10081) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-09-27 |