| NPI | 1306502422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT144415) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA APCC10310) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2024-01-17 |