| NPI | 1144046699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT136385) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA APCC12822) |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2025-10-13 |