| NPI | 1134703325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 145589) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 16039) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2024-06-27 |