| NPI | 1295482073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 159995) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 21277) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2025-12-15 |