| NPI | 1225821721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 164500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 23060) |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2026-09-30 |