| NPI | 1124697974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 10557) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT128815) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2025-05-19 |