| NPI | 1336276997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT5215) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA LCS7921) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2025-09-11 |