| NPI | 1275125908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 146607) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 10995) |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2024-05-07 |