| NPI | 1205343282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 21548) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 21548) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2026-01-12 |