| NPI | 1164142238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 159517) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 138290) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2026-06-03 |