| NPI | 1265153613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144607) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 15605) |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2026-07-10 |