| NPI | 1114051703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 160349) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2026-05-19 |