| NPI | 1295407484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 146703) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2024-12-06 |