| NPI | 1245655943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT151146) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2024-12-10 |