| NPI | 1154565604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 132143) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 63380) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2023-08-14 |