| NPI | 1215690250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T3420) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 148556) |
| 106H00000X Marriage & Family Therapist (Licence: CA 126621) | |
| 101YM0800X Counselor, Mental Health (Licence: CA AMFT126621) | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2026-07-13 |