| NPI | 1255006953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135881) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 17021) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-08-16 |