| NPI | 1285196022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 161213) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 21815) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-06-11 |