| NPI | 1164270047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144864) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 15790) |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-10-21 |