| NPI | 1336500792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112119) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: 89941) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2025-10-31 |